Acute toxoplasmosis in nonstem cell transplant patients with haematological malignancies: a study from a regional cancer institute in South India

Adurthi, Sreenivas; Sahoo, TP; Chakka, Kumar; Radhika, B.; Appaji, L.; Bapsy, P P; Ramesh, C.; Jayshree, R. S.

doi:10.1002/hon.864

Cited by 8 publications

(7 citation statements)

References 24 publications

(21 reference statements)

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“…We had earlier reported that 14% of febrile episodes in HM patients had B1 gene of the parasite in the blood with 1.9% of the cases being acute infections. 6 The frequency of acute toxoplasmosis during the present series was the same as reported by us earlier and so, the vast majority had reactivation of latent infection, which is the norm. 19 However, the overall frequency of toxoplasmosis in the present study was a little lower compared to our previous report-9.5% vs. 14%.…”

Section: Discussionsupporting

confidence: 88%

“…19 However, the overall frequency of toxoplasmosis in the present study was a little lower compared to our previous report-9.5% vs. 14%. 6 This drop in frequency could be explained due to cotrimoxazole prophylaxis, which is routinely instituted for the prevention of pneumocystis pneumonia during chemotherapy of paediatric ALL at our centre and majority of the patients in the present study were children. This perhaps also explains absence of symptomatic disease in any of the 20 patients who had the parasite DNA in the blood.…”

Section: Discussionmentioning

confidence: 72%

“…5 We had earlier shown that about 14% of febrile episodes in nonstem cell transplant patients with HM were attributed to T. gondii infection. 6 About thirty years ago, T. gondii isolates from humans and animals were shown to belong to only three types (I, II and III). 7 Accordingly, globally, the parasite was assumed to be clonal.…”

Section: Introductionmentioning

confidence: 99%

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Genotypes of T. Gondii in Patients With Haematological Malignancies at a State Cancer Institute in South India

Vijaykumar¹,

R²,

Rajendran³

et al. 2017

Jebmh

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BACKGROUND Toxoplasma gondii (T. gondii) is considered to be an important opportunistic pathogen in immunocompromised patients. After the advent of highly-activated antiretroviral therapy, though the frequency of opportunistic toxoplasmosis in the developed world has decreased, it continues to be a crucial aetiology of focal brain lesions in AIDS in developing countries such as India. Likewise, toxoplasmosis is a common infectious complication in patients with Haematological Malignancies (HM) on Stem Cell Therapy (SCT). Non-stem cell transplant patients treated with aggressive immunosuppressive regimens are also at risk for this opportunistic parasitic infection. We had earlier shown that about 14% of febrile episodes in non-stem cell transplant patients with HM were attributed to T. gondii infection. The aim of the study was to identify genetic types of Toxoplasma gondii (T. gondii) during febrile episodes in patients with Haematological Malignancies (HM). MATERIALS AND METHODS Febrile episodes in 210 patients with HM were investigated for T. gondii infection during November 2012 to April 2013. Blood samples were tested for B1 gene of the parasite and DNA from the positive episodes was taken up for multilocus PCR-Restriction Fragment Length Polymorphism (RFLP) genotyping. Direct amplification of 10 different loci, viz. SAG1, 5'-3'SAG2, alt. SAG2, SAG3, BTUB, GRA6, C22-8, L358, PK1 and APICO followed by RFLP was used to genotype the parasite. Sera from samples with amplifiable T. gondii B1 gene were also tested for IgM and low avidity IgG antibodies to the parasite.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 72%

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Genotypes of T. Gondii in Patients With Haematological Malignancies at a State Cancer Institute in South India

Vijaykumar¹,

R²,

Rajendran³

et al. 2017

Jebmh

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“…In conclusion, this study points to the need for standardization of prevention policies in transplant patients and for identification of new groups of at-risk patients who may benefit from chemoprophylaxis, such as patients with hematological malignancies, as recently underlined (38). Allo-HSCT clearly appears to be the main risk factor, and the better outcome of these patients in centers who have implemented a regular biological follow-up using blood PCR introduces an interesting perspective.…”

Section: Discussionmentioning

confidence: 66%

Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study

et al. 2015

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T oxoplasmosis is a widespread parasitic infection that is frequently asymptomatic in immunocompetent patients. However, this obligate intracellular protozoan parasite can evade the immune system (1, 2) and persist for the life of its host in cyst form, predominantly in the brain, retina, and muscles. Reactivation of latent cysts may occur when the immune system fails to maintain cytokine pressure, which mainly relies on gamma interferon (IFN-␥) (3). Cyst reactivation can lead to ocular toxoplasmosis, cerebral toxoplasmosis (CT), or disseminated toxoplasmosis, which involves most frequently the lungs but potentially all organs. Failure of an efficient Th1 immune response mainly results from acquired immunosuppression, through HIV infection or immunosuppressive therapy. Both primary acquired and reactivated infections are life-threatening in immunocompromised patients (ICPs). Definitive diagnosis can be obtained by the detection of parasites in blood, cerebrospinal fluid (CSF), bronchoalveolar lavage (BAL) fluid, or virtually any tissue by using PCR, which is the most sensitive method (4).Prevention of CT in patients with HIV is an object of consensus, and guidelines recommend co-trimoxazole (sulfamethoxazole-trimethoprim) chemoprophylaxis in Toxoplasma-seropositive patients when CD4 ϩ cell counts fall below 200 cells/l (4), a prophylactic regimen which also protects patients from Pneumocystis jirovecii pneumonia. Nevertheless, toxoplasmosis remains Citation Robert-Gangneux F, Sterkers Y, Yera H, Accoceberry I, Menotti J, Cassaing S, Brenier-Pinchart M-P, Hennequin C, Delhaes L, Bonhomme J, Villena I, Scherer E, Dalle F, Touafek F, Filisetti D, Varlet-Marie E, Pelloux H, Bastien P. 2015. Molecular diagnosis of toxoplasmosis in immunocompromised patients: a 3-year multicenter retrospective study.

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“…A PCR analysis on the peripheral blood was not performed in our patient, but such an analysis may be helpful and has been used in studies of HSCT. However, its diagnostic performance in cancer patients has not yet been sufficiently validated [11].…”

Section: Discussionmentioning

confidence: 99%

Disseminated Toxoplasmosis in a Patient with Non-Hodgkin Lymphoma

et al. 2009

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Toxoplasmosis is a well-recognized opportunistic disease in HIV-infected individuals that is caused by the reactivation of a previous infection, primarily in the central nervous system, during profound immunodeficiency. Toxoplasmosis has been described more rarely in patients with cancer and chemotherapy. We report a case of a patient with a history of chemotherapy for non-Hodgkin lymphoma who developed pain and progressive paresthesia of the right arm 6 weeks after remission. Relapsing lymphoma was suspected, and steroid and radiation treatment were initiated, but the patient died 5 days later due to multiple organ failure. Autopsy revealed disseminated toxoplasmosis. This case illustrates that toxoplasmosis should be suspected in patients with neoplastic disease, especially lymphomas, who present with unexplained neurologic, pulmonary, or febrile symptoms during or after chemotherapy.

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Acute toxoplasmosis in nonstem cell transplant patients with haematological malignancies: a study from a regional cancer institute in South India

Cited by 8 publications

References 24 publications

Genotypes of T. Gondii in Patients With Haematological Malignancies at a State Cancer Institute in South India

Genotypes of T. Gondii in Patients With Haematological Malignancies at a State Cancer Institute in South India

Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study

Disseminated Toxoplasmosis in a Patient with Non-Hodgkin Lymphoma

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